October 26, 2010
Health Care Vote Puts Democrats on Defensive
By KEVIN SACK

CHARLOTTESVILLE, Va. — At the start of their debate here last week, the Republican challenger for Congress, State Senator Robert Hurt, paused only long enough to thank the League of Women Voters before ripping into Representative Tom Perriello for voting for “government-run health care.” Mr. Hurt returned to the topic seven times over the next hour, despite being asked only once.

If Mr. Hurt was reading from his party’s playbook, so was Mr. Perriello, a freshman Democrat scrapping to survive in the centrist Fifth Congressional District, which spans central and southern Virginia. He emphasized that the health law had preserved the private insurance system, and that he had already been thanked by constituents who can “go to bed at night not having to worry” that they will be bankrupted by disease. Then he asked for a chance to improve an imperfect law.

“This doesn’t change overnight,” Mr. Perriello said, “but we are moving in the right direction.”

That interplay has been replicated across the 2010 campaign, with Republicans largely keeping Democrats on the defensive about the Obama presidency’s signature domestic achievement. While clearly secondary to economic concerns, the continuing debate over health care has remained prominent in numerous races for the House and Senate.

President Obama, who typically has not campaigned for individual House members, plans to make an exception on Friday by appearing here with Mr. Perriello, the White House said Monday.

Health care also has played a role in contests for governor and attorney general, the winners of which will have a say in carrying out the new law. And three states — Arizona, Colorado and Oklahoma — will be voting on largely symbolic ballot initiatives intended to invalidate the law’s requirement that their residents have health insurance.

In Congressional races, a centerpiece of the Republican strategy has been to use Democratic “yes” votes on the law to tar incumbents as advocates of expansive government and lock-step followers of their party’s leadership.

Opponents of the legislation, including independent groups, have spent $108 million since March to advertise against it, according to Evan L. Tracey, president of the Campaign Media Analysis Group, which tracks advertising.

That is six times more than supporters have spent, including $5.1 million by the Department of Health and Human Services to promote the new law, Mr. Tracey said. In one of the government’s ads, the 84-year-old actor Andy Griffith promises older Americans that “with the new health care law, more good things are coming.”

The National Republican Congressional Committee, which bought advertising for 62 of its House candidates, cited Democratic votes for the law in half of those districts, including Mr. Perriello’s.

“When Congress passed a government takeover of health care, Tom Perriello toed the party line every single time,” says a narrator in the ad, which also mentions Mr. Perriello’s votes for the stimulus and cap-and-trade energy bills.

The Democrats’ inability to control the messaging during the legislative debate bled unstaunched into the campaign, as Republicans appealed to base voters with a bumper-sticker pledge to repeal the law or, if unable, to drain its financing.

Their cause has been helped by early indications that federal judges in two districts are seriously considering the law’s constitutionality (a third judge has already upheld it). The Republicans also benefited from premium increases and market withdrawals that insurers and employers blamed on requirements for expanded coverage, bringing a furious response from the Obama administration.

Polling on the law shows that the electorate remains split along partisan lines, with independents leaning against it. The evolving Democratic response has varied therefore by geography and political circumstance.

Strikingly, just after Labor Day, the only House Democrats with television ads on the health care law were among the 34 who broke with the party to vote against it. Some of those incumbents have used their votes to demonstrate independence from, and even antagonism toward, the House speaker, Nancy Pelosi (while being careful not to alienate black voters by similarly confronting Mr. Obama).

“I voted against Nancy Pelosi’s trillion-dollar health care bill, because we can’t afford it,” says Representative Jim Marshall, a Democrat, in an ad broadcast in his middle Georgia district. “That’s just one reason why I won’t support her for speaker.”

In West Virginia, a state with few black voters, Gov. Joe Manchin III, the Democratic candidate for Senate, pledges in one of his ads to “repeal the bad parts of Obamacare.” (Yet, in another ad, Mr. Manchin attacks his opponent for opposing the elimination of pre-existing condition exclusions, which the governor presumably considers one of the good parts of “Obamacare.”)

In select districts, however, Democratic candidates have gradually come to defend and even embrace the law’s most popular provisions, perhaps because Republican attacks have left them little choice.

It helped, as intended, when many of those changes took effect on Sept. 23, including requirements that insurers cover children with pre-existing illnesses, cover children up to age 26 on parental policies and eliminate lifetime caps on benefits. Mr. Perriello, with reporters in tow, stopped by a Charlottesville doctor’s office the day before to promote those provisions.

The Democrats have been less enthusiastic about promoting the requirement, starting in 2014, that most Americans obtain insurance or the coming tax-financed expansion of subsidized insurance.

“You can argue the Democrats should have done more with the popular parts of the bill,” said Jonathan B. Oberlander, who teaches health care politics at the University of North Carolina at Chapel Hill, “and this speaks to the problem they have selling it, especially to insured Americans.”

At least three Democratic senators and seven House incumbents, including Mr. Perriello, have run commercials extolling the new insurance regulations. Some have directly attacked their repeal-minded opponents, as has Mr. Obama.

“The American people may have heard a lot of arguments on Capitol Hill,” he said at a party fund-raising dinner in Minneapolis on Saturday. “But when they see what actually is being delivered, I don’t think the Republicans are going to feel so good about this repeal call.”

The second part of the Democratic response, typically delivered in debates and interviews, has been more penitent, acknowledging that the legislation emerged from an unseemly process with considerable risks and flaws.

The Democratic Senate nominee in Illinois, State Treasurer Alexi Giannoulias, was asked in a recent debate with his Republican opponent, Representative Mark Steven Kirk, whether he was running on health care reform.

“I am running on jobs; I am running on helping small businesses,” Mr. Giannoulias said. “Look, the health care bill was far from a perfect vehicle. That being said, I think it did some important things that the congressman wants to repeal.”

Mr. Perriello, in his debate with Mr. Hurt, volunteered that he was disappointed that the law had not altered the medical tort system.

“I don’t think it makes sense to stand for something and run away from it,” Mr. Perriello said in an interview the next day. “On the other hand, I don’t think there’s a single person in the country who didn’t have a better bill in mind.”